Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy

Michael Rink, Jens Hansen, Eugene K. Cha, David A. Green, Marko Babjuk, Robert Svatek, Evanguelos Xylinas, Scott T. Tagawa, Talia Faison, Giacomo Novara, Pierre I. Karakiewicz, Siamak Daneshmand, Yair Lotan, Wassim Kassouf, Hans Martin Fritsche, Armin Pycha, Evi Comploj, Derya Tilki, Patrick J. Bastian, Felix K. ChunRoland Dahlem, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease. Patients and Methods: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215). Results: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- sd) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively). Conclusions: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)74-84
Number of pages11
JournalBJU International
Volume111
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Cystectomy
Lymph Nodes
Neoplasm Metastasis
Urinary Bladder
Carcinoma
Neoplasms
Adjuvant Chemotherapy
Lymph Node Excision
Survival
Radiotherapy
Survival Rate
Recurrence
Drug Therapy

Keywords

  • adjuvant chemotherapy
  • bladder cancer
  • lymph node metastasis
  • nomogram
  • radical cystectomy
  • survival
  • urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy. / Rink, Michael; Hansen, Jens; Cha, Eugene K.; Green, David A.; Babjuk, Marko; Svatek, Robert; Xylinas, Evanguelos; Tagawa, Scott T.; Faison, Talia; Novara, Giacomo; Karakiewicz, Pierre I.; Daneshmand, Siamak; Lotan, Yair; Kassouf, Wassim; Fritsche, Hans Martin; Pycha, Armin; Comploj, Evi; Tilki, Derya; Bastian, Patrick J.; Chun, Felix K.; Dahlem, Roland; Scherr, Douglas S.; Shariat, Shahrokh F.

In: BJU International, Vol. 111, No. 1, 01.2013, p. 74-84.

Research output: Contribution to journalArticle

Rink, M, Hansen, J, Cha, EK, Green, DA, Babjuk, M, Svatek, R, Xylinas, E, Tagawa, ST, Faison, T, Novara, G, Karakiewicz, PI, Daneshmand, S, Lotan, Y, Kassouf, W, Fritsche, HM, Pycha, A, Comploj, E, Tilki, D, Bastian, PJ, Chun, FK, Dahlem, R, Scherr, DS & Shariat, SF 2013, 'Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy', BJU International, vol. 111, no. 1, pp. 74-84. https://doi.org/10.1111/j.1464-410X.2012.11356.x
Rink, Michael ; Hansen, Jens ; Cha, Eugene K. ; Green, David A. ; Babjuk, Marko ; Svatek, Robert ; Xylinas, Evanguelos ; Tagawa, Scott T. ; Faison, Talia ; Novara, Giacomo ; Karakiewicz, Pierre I. ; Daneshmand, Siamak ; Lotan, Yair ; Kassouf, Wassim ; Fritsche, Hans Martin ; Pycha, Armin ; Comploj, Evi ; Tilki, Derya ; Bastian, Patrick J. ; Chun, Felix K. ; Dahlem, Roland ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy. In: BJU International. 2013 ; Vol. 111, No. 1. pp. 74-84.
@article{5ef337e695c3482cac16b36da0a5864a,
title = "Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy",
abstract = "Objectives: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease. Patients and Methods: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215). Results: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5){\%}. Within a median follow-up of 41 months, the mean (+/- sd) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3){\%} and 46 (3){\%}, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively). Conclusions: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.",
keywords = "adjuvant chemotherapy, bladder cancer, lymph node metastasis, nomogram, radical cystectomy, survival, urothelial carcinoma",
author = "Michael Rink and Jens Hansen and Cha, {Eugene K.} and Green, {David A.} and Marko Babjuk and Robert Svatek and Evanguelos Xylinas and Tagawa, {Scott T.} and Talia Faison and Giacomo Novara and Karakiewicz, {Pierre I.} and Siamak Daneshmand and Yair Lotan and Wassim Kassouf and Fritsche, {Hans Martin} and Armin Pycha and Evi Comploj and Derya Tilki and Bastian, {Patrick J.} and Chun, {Felix K.} and Roland Dahlem and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",
year = "2013",
month = "1",
doi = "10.1111/j.1464-410X.2012.11356.x",
language = "English (US)",
volume = "111",
pages = "74--84",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy

AU - Rink, Michael

AU - Hansen, Jens

AU - Cha, Eugene K.

AU - Green, David A.

AU - Babjuk, Marko

AU - Svatek, Robert

AU - Xylinas, Evanguelos

AU - Tagawa, Scott T.

AU - Faison, Talia

AU - Novara, Giacomo

AU - Karakiewicz, Pierre I.

AU - Daneshmand, Siamak

AU - Lotan, Yair

AU - Kassouf, Wassim

AU - Fritsche, Hans Martin

AU - Pycha, Armin

AU - Comploj, Evi

AU - Tilki, Derya

AU - Bastian, Patrick J.

AU - Chun, Felix K.

AU - Dahlem, Roland

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2013/1

Y1 - 2013/1

N2 - Objectives: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease. Patients and Methods: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215). Results: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- sd) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively). Conclusions: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.

AB - Objectives: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease. Patients and Methods: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215). Results: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- sd) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively). Conclusions: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.

KW - adjuvant chemotherapy

KW - bladder cancer

KW - lymph node metastasis

KW - nomogram

KW - radical cystectomy

KW - survival

KW - urothelial carcinoma

UR - http://www.scopus.com/inward/record.url?scp=84871608722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871608722&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2012.11356.x

DO - 10.1111/j.1464-410X.2012.11356.x

M3 - Article

C2 - 22809039

AN - SCOPUS:84871608722

VL - 111

SP - 74

EP - 84

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 1

ER -